Gender-based differences in mortality in response to high product ratio massive transfusion.
BACKGROUND: Recent data suggest that patients undergoing massive transfusion have lower mortality rates when ratios of plasma and platelets to red blood cells (RBCs) of ≥ 1:2 are used. This has not been examined independently in women and men. A gender dichotomy in outcome after severe injury is known to exist. This study examined gender-related differences in mortality after high product ratio massive transfusion. METHODS: A retrospective study was conducted using a database containing massively transfused trauma patients from 23 Level I trauma centers. Baseline demographic, physiologic, and biochemical data were obtained. Univariate and logistic regression analyses were performed. Adjusted mortality in patients receiving high (≥ 1:2) or low (<1:2) ratios of plasma or platelets to RBCs was compared in women and men independently. RESULTS: Seven hundred four patients were analyzed. In males, mortality was lower for patients receiving a high plasma:RBC ratio at 24 hours (20.6% vs. 33.0% for low ratio, p = 0.005) and at 30 days (34.9% vs. 42.8%, p = 0.032). Males receiving a high platelet:RBC ratio also had lower 24-hour mortality (17.6% vs. 31.5%, p = 0.004) and 30-day mortality (32.1% vs. 42.2%, p = 0.045). Females receiving high ratios of plasma or platelets to RBCs had no improvement in 24-hour mortality (p = 0.119 and 0.329, respectively) or 30-day mortality (p = 0.199 and 0.911, respectively). Use of high product ratio transfusions did not affect 24-hour RBC requirements in males or females. CONCLUSION: Use of high plasma:RBC or platelet:RBC ratios in massive transfusion may benefit men more than women. This may be due to gender-related differences in coagulability. Further study is needed to determine whether separate protocols for women and men should be established.
Rowell, SE; Barbosa, RR; Allison, CE; Van, PY; Schreiber, MA; Trauma Outcomes Group, ; Holcomb, JB; Wade, CE; Brasel, KJ; Vercruysse, G; MacLeod, J; Dutton, RP; Hess, JR; Duchesne, JC; McSwain, NE; Muskat, P; Johannigamn, J; Cryer, HM; Tillou, A; Cohen, MJ; Pittet, JF; Knudson, P; De Moya, MA; Schreiber, MA; Tieu, B; Brundage, S; Napolitano, LM; Brunsvold, M; Sihler, KC; Beilman, G; Peitzman, AB; Zenait, MS; Sperry, J; Alarcon, L; Croce, MA; Minei, JP; Kozar, R; Gonzalez, EA; Stewart, RM; Cohn, SM; Mickalek, JE; Bulger, EM; Cotton, BA; Nunez, TC; Ivatury, R; Meredith, JW; Pomper, P; Pomper, GJ; Marin, B
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